Dr. P. MURUGAN,
M.Sc., M.Phil., Ph.D.,Assistant Professor and Principal i/c Department of Biochemistry,
Bharathidasan University Model College,
Vedharanyam - 614 810.
Respiration – (Breathing in – Breathing out – Pause)
The action of breathing in and the process of gas exchange in the lungs and breathing out CO2 is called as RESPIRATION..
Every part of the body (cells) use oxygen for life and energy and the nerve cells in the brain use more. They cannot survive for more than three minutes without oxygen.
Respiratory System- Organs Nose – Mouth – Lung – Cells Structures
Windpipe – bronchus – air sacks – Epiglottis – Muscles in the chest wall – Diaphragm
Respiratory centre in the brain control volume, depth, rate – increased or decreased .
Asphyxia – Causes
Insufficient oxygen is due to smoke or gas – Changes in atmospheric pressure as at high altitudes – or in depressurized air-craft
Air-way obstruction
Due to smothering by a pillow, water (drowning) – blockage by vomit, food, foreign body, tongue falling back – bronchial asthma
Swelling in the air passage due to burns and poisons
Compression of wind pipe due to hanging and strangulation Conditions affecting chest wall
Crushing : Fall of earth or sand – pressure from crowd
Chest wall injury : Multiple rib fracture ( Flail chest), constricting burns Diseases : Epilepsy – Tetanus – Rabies
Impaired Lung Function
Lung injury (sucking wound), Pneumothorax (air in lungs)
Haemothorax (blood in lungs) – Collapsed lung – Lung infections – Pneumonia.
Damage to the brain – Respiratory Centre
Head Injury or stroke, poisoning, Electric shock, lightening, Paralysis of nerves, muscles of breathing as in spinal cord injury or paralysis of Diaphragm.
Impaired oxygen uptake by the tissues
Due to carbon monoxide poisoning – cyanide poisoning
3 to 4 minutes deprivation of oxygen to brain – function begins to fail – consciousness will be lost – breathing and heart beat will stop – death may result.
Breathing rate can be altered voluntarily or involuntarily by the
respiratory centre in the brain in response to abnormal level of
carbon di-oxide, low levelof oxygen, stress, exercise, injury or
illness.
Inhalation of fumes
Smoke from fire, Low in oxygen, gases or toxic vapaours, burning plastics, foam padding , synthetic wall coverings, and screens
Carbon Monoxide : Exhaust fumes of motor vehicles, smoke from fire, back draughts from blocked chimney flues, emission from gas heaters.
Carbon di-oxide : Accumulates – get concentrated in deep enclosed spaces – pits – wells and ground level reservoirs.
Solvents : Glues and cleaning fluids
Fuels : Lighter – camping gas – propane fuelled stoves and LPG
Recognition : Irritation of air-passages – spasm – swelling – noisy- rapid- distressed breathing – head ache – vomiting – some fuels are cold, when inhaled cause cardiac arrest.
Treatment – Smoke : Bend low in gas filled room with safety equipments or Wet kerchief around mouth and nose. Phone for ambulance – remove casualty to fresh air – extinguish fire or smoldering clothes.
If unconscious – ABC – If breathing, pulse present- recovery position If oxygen available, give oxygen. Treat burns and other injuries.
Stay – Check pulse- respiration – level of response every 10 minutes.
DO NOT ENTER A GAS FILLED ROOM WITHOUT A QUICK AND EASY WAY OF ESCAPE .
Choking :
A foreign object that is struck at the back of throat may either block the throat or induce muscular spasm
Causes
Trying to swallow large quantities of poorly chewed food - food hurriedly swallowed.
Drinking alcohol before or during meals (Alcohol dulls the nerves that aid swallowing.)
Wearing Dentures make it difficult to sense whether the food is fully chewed before it is swallowed.
Eating while talking excitedly or laughing , Eating too fast Walking, Playing or running with food or objects in the mouth Recognition
Difficulty in speaking and breathing-congested face initially – Grey blue skin (Cyanosis) later.
Distressed signs from casualty who may point to the throat or grasp at the neck.
Choking – Conscious Adult
• Ask the person “Are you choking?” If the person speaks or coughs, do not interfere.
• Cannot speak or cough – give abdominal thrusts. Stand behind – one leg between the legs of the victim – arms around – make a fist with one hand and position with thumb side
against the abdomen – then grasp fist with other hand below the rib cage (above belly button), pull sharply inward and upward.
• Continue abdominal thrusts until the obstruction
clears or he becomes unconscious.
For an unconscious adult
1. Holding the victim’s chin with fingers, place your thumb inside the mouth to hold the tongue. Hold tongue and jaw firm, lift the jaw with other hand, use index finger as a hook, remove foreign body.
2. Open airway – give two breaths – if the blockage remains, reposition the head and try again. If still, rescue breath cannot be given, begin CPR.
Kneel beside – place hands one on top of the other (heel of one hand on the middle of breast bone), fingers off.
3.
Perform chest compressions as for CPR. Repeat items 1 and 2 above. After each series of 30 compressions, two breaths until the
obstruction is ejected.
4.
Rescue breathing is
successful or victim starts to breathe again on his own.
5.
If he breaths normally – in
recovery position, monitor
and record breathing, pulse,
response – every ten minutes
Choking for Children
For a Conscious Child (1 to 7 years)
• Ask the child “Are you choking?”. If the child can speak or cough, do not interfere. If not proceed to.
• Make fist with one hand and place the thumb side of your fist against the middle of the abdomen above navel from behind.
• Grasp your fist with your other hand and then press into the abdomen with a quick upward thrust.
• Continue abdominal thrusts until the obstruction clears or until the child becomes unconscious.
For an Unconscious Child
Hold Child’s chin with your finger – place thumb inside the mouth to hold the tongue.
Holding tongue and jaw firmly, lift the jaw to open airway. With the other index finger – as a hook – to remove any foreign body from the mouth.
Open airway. Attempt to ventilate twice. If the blockage still remains reposition the head
again – ventilate. If still cannot breathe-- begin
CPR.Kneel beside – place one hand on the middle of chest – perform 30 chest compressions.
Repeat steps 1 and 2 above after each set of 30 compressions until obstruction is rejected, rescue breathing is successful or the victim starts to breathe again on his own.
Assessing Treatment:
• Every time you complete steps 2, 3 and 4, before going on to the next one
• Do not use your fingers to feel blindly down the throat.
• If the child begins to breathe, place her in the
recovery position. If the child not breathing- attempt to give up two breaths of mouth to mouth ventilation.
• If the chest does not rise, try to ventilate, proceed to steps 3 and 4.
Baby Choking ( 0 to 12 months)
If the baby cannot cough or breathe, and starts to turn blue perform the choking sequence.
Lay the baby face down on forearm, supporting his head and chest. Give up to five sharp blows on his back with fingers.
Check baby’s mouth – remove any obstruction with one finger.
Do not feel blindly down the throat.
If this fails, use two fingers to give the baby up to 30 chest thrusts after turning the baby on your forearm face upwards supporting underneath with the thigh. ( one finger width below the centre line – connecting nipple – on the breast bone. )
Check the baby’s mouth, remove obstruction – do not use abdominal thrust on a baby.
If the obstruction has not cleared, repeat steps 1
to 4 three times, call for ambulance - repeat 1 to
4.
Choking
If you are alone and choking, lean over and press your abdomen against any object or can give yourself abdominal thrust by using your own hands.
Choking
Give chest thrusts instead of Abdominal thrusts to a choking person obviously
pregnant or known to be pregnant or too big for you to reach around.
Choking victim on a wheel chair.
DROWNING
In Drowning death occurs not because of lungs are full of water but because of throat spasm which prevents breathing.
Casualty suffers from Asphyxia and Hypothermia Rescue: Choose the safest way
REACH WITH STICK
UNSAFE SAFE
THROW A BOARD THROW A CLOTH THROW A FLOAT
When bringing out of water carry head lower than her chest to minimise dangers of vomiting and inhalation
Stand astride; lift at the abdomen by both hands-- three or four times with a jerk to let out water
Lay down face upwards- clean the airway and open
Check breathing and pulse
Resuscitate if necessary (initially five times) Replace wet clothing – cover with dry sheets, bottom and top
If unconscious keep his head low and to one side for draining (recovery position.)
If conscious and breathing normally give him hot drinks. Move to hospital.
Electrical Shock / Injuries
Electric shock is produced only when electric current passes through the human body which is in contact with earth (quick if it is wet)
High Voltage : OH High tension cables, Railway OH lines – Usually fatal.
Severe burns, sudden muscular spasms may propel casualty some distance. High Voltage electric current may jump (arc) upto 18 meters or 20 yards.
Dry Wood or clothing will not protect. Power to cut off or – Isolated.
Low Voltage : Homes, offices, shops.
Faulty switches – Flayed defects in appliances.
Standing or handling in wet conditions.
Turn off electricity – unplug, stand on wooden box, stool, rubber or plastic mat, thick bundle of newspapers , telephone directory. Push with wooden broom, dry rope – Loop – feet or arms pull away.Last resort; tug at loose dry clothing – pull away
Effects
• Temporary paralysis of breathing mechanism
• stunning of heart ( fatal paralysis of heart)
• Heart races madly – fails to pump blood (induces ventricular fibrillation)
• Burns – superficial or deep
• falls with fractures and bleeding.
Never climb on electric pylon or pole to render first aid
The pathway of current passing through the body is another deciding factor
A current passing through heart usually results in fatality Power lines fallen across vehicle – stay inside – when fire threatens jump out of the vehicle without touching the body or wire.
Treatment
• Call for an emergency services
• If unconscious check ABC – Resuscitate if necessary
• If breathing with pulse – but unconscious, place him in a Recovery position.
• Treat for burns with wet cloth for ten minutes at the point of entry and exit of current . Then cover with dry clothes
• Treat for shock
• Treat for fracture and other injuries
• They are prone to stop breathing suddenly. Be prepared to resuscitate at once. Keep in the hospital for 48 hours.
Lightning
Natural burst of electricity – seeks contact through tall features – anyone standing by it, sets clothes on fire. Knocks him down – rarely causes instant death. Move from site – ABC – Treat for burns – Move to hospital.
If Unconscious : A-B-C--- resuscitate
If not place in recovery position. (handle neck carefully).
Buried in sand : Remove earth or sand as far back as the hips – chest can be spared for expanding. A - B – C
Swelling in the throat:
If normal give ice to suck – cold water to drink – Butter – olive oil – medicinal paraffin to apply.
Hot water fomentation to the front of the throat. If no breathing A-B-C
Asthma Attack : Distressing condition in which the muscles of air passages go into spasm and constrict, making breathing (particularly breathing out) difficult.
Reasons : Allergy – nervous tension – prone for sudden attacks in nights Signs & Symptoms: Difficulty in breathing with a long breathing out
Wheezing – when breathing out
Distress – anxiety – speaks only with difficulty- in whispers Blueness of skin (Cyanosis)
In severe attack, breathing causes exhaustion Rarely becomes unconscious – stop respiration
Treatment
Reassure – calm the casualty – Help to sit down – slightly forward, resting on a support- ensure good supply of fresh air- tell to take slow deep breaths
If the casualty has medication let her use it (Puffer or aerosol)
If no response for medication and severe distress in respiration phone for ambulance
Check and record breathing, pulse every ten
minutes- if the attack is mild and eases within 5 to 10 minutes encourage casualty to take another dose from inhaler.
Move the casualty in ambulance in a sitting position and advise her to see the doctor.
Hyper ventilation : Due to acute anxiety, hysteria or panic attack, fright or shock
Treatment : Speak firmly but kindly- move to a quiet place.- .if tingling or cramps persists to re- breathe expired air from a paper bag.
Hanging – Strangling and Throttling
Hanging : Suspension of body by a noose around neck.
Strangling : Cutting of air supply to lungs by constriction around the neck Throttling : Cutting off air supply – squeezing a person’s throat
• Marks around neck – articles used
• Rapid distressed breathing
• Impaired consciousness
• Blueness of the skin
• congestion of face – neck veins prominent
• Tiny red spots on the face or white of eyes
• May cause broken neck Treatment
Lifting and supporting the body without the weight acting on noose.
Quickly remove constriction.
Do not destroy or interfere with evidence (knots) that the police may need.
Croup : Attacks of severe breathing difficulties caused by inflammation of wind pipe and larynx in infants. Occurs at night or before the child settles. May accompany fever or due to epiglottitis (infected and swollen)
Signs and Symptoms :Short barking cough Crowing or whistling noise on breathing in Blue skin
Treatment : Sit the child up-- support her back - reassure her
Make the child breathe in steam to ease her ( kitchen or bathroom hot tap) Create humid atmosphere in the room where child is put back to rest
Do not stick your fingers down the child’s throat Do not panic.
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